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RW424771 University of South Alabama (Active)
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Main Details
Name
University of South Alabama
Subdivision Name
Family Specialty Clinic
Type
Ryan White Part D
340B ID
RW424771
Grant Number
H12HA24771
Additional Details
Current Program Status
Active
Registration Date
1/7/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/17/2020
Last Recertification Date
2/12/2025
Time Period the Assistance was Received
8/1/2022 - 7/31/2026
Contacts
Authorizing Official
USA Health Systems
Kristen Roberts, Chief Financial Officer
(251) 460-6241
Primary Contact
University of South Alabama
Theresa Miller, Program Coordinator
(251) 471-7179
Addresses
Street Address
2451 University Hospital Drive
Mastin 102
Mobile, AL 36617
Billing Address
University of South Alabama Family Specialty Clinic
2451 University Hospital Drive
Moorer Building 1620
Mobile, AL 36617
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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